Hierarchical condition categories program

ABSTRACT

Systems and methods of recording patient&#39;s medical documents and training programs for improving medical document recordation. The system includes a computer readable medium capable of storing medical data obtained from patients, including disease codes, a computer with software capable of evaluating the data stored on the computer readable medium for completeness, and a notification system capable of presenting to the user of the system a warning if any of the data is found to be incomplete or incorrect. The training includes evaluating the healthcare provider&#39;s current medical documentation process, training the healthcare provider in methods of recording medical documents, providing a system for recording medical documents, and training the healthcare provider in use of the system.

CROSS-REFERENCE TO RELATED APPLICATIONS

Not Applicable

STATEMENT RE: FEDERALLY SPONSORED RESEARCH/DEVELOPMENT

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BACKGROUND

The present invention is directed toward improved systems and methodsfor collecting and reporting Hierarchical Condition Categories (HCC).More particularly, the present invention comprises training programs andsoftware systems useful by health plans and medical practitioners tomore accurately code and report HCC to comply with the Centers forMedicare and Medicaid Services (CMS) documentation and reportingrequirements.

Essential to high quality and cost-effective healthcare is the properdiagnosis of a patient's condition. From a proper diagnosis, theappropriate medical attention utilized to treat the underlyingcondition, whether it be the performance of a medical procedure,laboratory tests, and/or prescription of medication, can be determined.To that end, and as is well-known in the art, standard diagnoses codesare extensively utilized pursuant to conventional disease classificationtechniques that provide a quick, well-understood method to documentmedical care administered to a patient. Exemplary of, and perhaps mostwidely utilized of such formats, is the International Classification ofDiseases 9th Edition (ICD-9) three digit codes. Likewise, with respectto the medical treatment that has been rendered, such procedures aretypically referenced according to Current Procedural Terminology (CPT).Also frequently referenced in connection with the delivery of healthcareare drug codes (e.g., National Drug Code, or NDC), other service codes(e.g., Healthcare Common Procedure Coding System, or HCPCS), amongothers.

The Balanced Budget Act of 1997 (BBA) mandated a change in Medicare'spayment methodology intended to pay health plans, and subsequentlymedical providers, based on a patient's health status through a processcalled Risk Adjustment Factor (RAF). Prior to the implementation of riskadjustment, reimbursement was based solely on demographic factors, suchas, age, sex, Medicaid status, county of residence, etc.

In 2004, the Centers for Medicare and Medicaid Services (CMS)implemented a new model, the Hierarchical Condition Categories (HCC), asan additive model to adjust Medicare capitation payments to privatehealthcare plans for their expenditure risk of enrollees based onserious or chronic conditions. In theory, the CMS-HCC model pays moreaccurately for predicted health expenditures, based on health status andsome demographic factors. In short, treat the patient appropriately andget reimbursed for doing so.

The collection and reporting of HCCs provides important benefits topatients and improves reimbursement. When health plans and/orpractitioners have their own programs for documenting, auditing, andreporting HCCs, there is an opportunity to identify those at-riskenrollees/patients who, because of their disease markers, would benefitfrom increased frequency of visits and intensity of services, enrollmentin complex care management, chronic care programs, and/or transitionalcare programs when appropriate - all designed to ensure the bestpossible clinical outcome for patients and cost savings for health plansand practitioners. Examples of such other programs are described in U.S.Pat. Nos. 7,657,442 and 7,464,041 and U.S. patent application Ser. Nos.11/352,028 and 12/834,767, the entire teachings of which arecollectively incorporated by reference herein.

Accordingly, there is a need in the art for a program designed to trainand support health plans and practitioners the art and skill ofcorrectly coding and reporting HCC to comply with CMS-HCC documentationand reporting requirements.

BRIEF SUMMARY

One aspect of the present invention is directed toward methods ofrecording a patient's medical documents. The methods include obtainingmedical data from the patient, storing the data in electronic medicalrecords embodied on a computer readable medium, evaluating the data viaa computer capable of interpreting said electronic medical records toensure that the data entry is complete, and presenting a notification toa user if any of the data is found to be incomplete or incorrect. Themedical data obtained from the patient may include any of variousrelevant data, such as demographic information, medications taken, andsymptoms suffered, but particularly includes disease codes. For example,the disease codes may be ICD-9 codes.

The data evaluation may take numerous forms, for example, whether foreach disease code there is recorded a corresponding diagnosis of thedisease, status of the disease, and plan of action for the diseaseand/or whether an improper code has been entered for each disease. Moreparticularly, the obtained disease code may be evaluated to determinewhether a more specific code should be used in its place. For example,whether a current disease has been improperly coded as a history of thedisease. Another possible evaluation is whether there are likely diseasecodes that the patient may be suffering from that were not recorded. Oneexample of this is when the patient is suffering from diabetes. Amajority of patients suffering from diabetes have complications due tothe diabetes. A notification may be provided to the user thatcomplications of diabetes should be properly coded.

The medical data obtained may further include medication prescriptionsof the patient and evaluating whether there is a linking disease codefor each medication prescription. Additionally, a notification may bepresented to the user of the system to review the medical records forcommonly unreported diagnosed diseases within a set population ofpatients. Examples of commonly unreported diagnosed diseases includechronic kidney disease, neuropathy, peripheral vascular disease, andmalnutrition.

Another aspect of the present invention is directed toward methods oftraining healthcare providers to properly record medical documents. Thistraining includes evaluating the healthcare provider's current medicaldocumentation process, training the healthcare provider in methods ofrecording medical documents, providing a system for recording medicaldocuments, and training the healthcare provider in use of the system.The system includes a computer readable medium capable of storingmedical data obtained from patients, including disease codes, a computerwith software capable of evaluating the data stored on the computerreadable medium for completeness, and a notification system capable ofpresenting to the user of the system a warning if any of the data isfound to be incomplete or incorrect.

In particular, the training provided may include instructing thehealthcare provider to ensure the medical documents are sufficientlydetailed and coded to achieve the correct RAF score for each patient.

Yet another aspect of the present invention contemplates a system forrecording medical documents. The system includes a computer readablemedium capable of storing medical data obtained from patients, includingdisease codes, a computer with software capable of evaluating the datastored on the computer readable medium for completeness, and anotification system capable of presenting to the user of the system awarning if any of the data is found to be incomplete or incorrect.

For example, the notification system may present a warning if a diseasecode does not have a corresponding recorded diagnosis of disease, statusof disease, and plan of action for the disease, if an improper diseasecode has been entered, if there are likely disease codes that have notbeen recorded and/or if a medical prescription is recorded without alinking disease code for the medication.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the various embodimentsdisclosed herein will be better understood with respect to the followingdescription and drawings, in which like numbers refer to like partsthroughout, and in which:

FIG. 1 is a flowchart depicting the steps for practicing the presentinvention as it relates to training healthcare providers in improvedmedical document recordation practices.

DETAILED DESCRIPTION

The detailed description set forth below is intended as a description ofthe presently preferred embodiment of the invention, and is not intendedto represent the only form in which the present invention may beconstructed or utilized. The description sets forth the functions andsequences of steps for constructing and operating the invention. It isto be understood, however, that the same or equivalent functions andsequences may be accomplished by different embodiments and that they arealso intended to be encompassed within the scope of the invention.

Referring now to FIG. 1, there is schematically illustrated the varioussteps by which a method of the present invention operates to trainhealthcare providers in improved medical document recordation practices.In particular, there is a first step 100 of evaluating the healthcareprovider's current medical document recordation processes. For example,a team consisting of physicians, nurses, and financial auditors mayconduct a two day on-site evaluation of the client's current HCCactivities to determine data extraction and reporting methodology andvalidates the client's current RAF score.

A written report may be given to the client outlining the team'sfindings and recommendations that include staffing requirements, systemrequirements, and/or a program training and implementation work plan.

The second step 200 includes a comprehensive educational trainingprogram. For example, the training program may be offered as a ten dayclass with overhead presentations, case studies, and reference material,with topics including risk adjustment methodology, documentationtraining, Hierarchical Condition Coding (including commonly unreportedor miscoded conditions), and training on systems for recording medicaldocuments. The training section 200 may include a ninety daypost-implementation followup with client's staff to evaluate programprogress and/or an at least annual update to keep client apprised ofchanges in the CMS-HCC model.

The third step 300 is providing to the healthcare provider a system forrecording medical documents, wherein the system includes at least acomputer readable medium capable of storing medical data obtained frompatients, wherein the data comprises disease codes; a computer withsoftware capable of evaluating the data stored on the computer readablemedium for completeness; and a notification system capable of presentingto the user of the system a warning if any of the data is found to beincomplete or incorrect. Examples of data to be recorded and warningsthat may be presented by the system are discussed in greater detailbelow.

Risk Adjustment Methodology and Documentation Training

In order for the diagnostic classification system of the presentinvention to function properly the following principles may be used: 1)diagnostic categories should be clinically meaningful; 2) diagnosticcategories should predict medical expenditures; 3) diagnostic categoriesthat will affect payments should have adequate sample sizes to permitaccurate and stable estimates of expenditures; 4) in creating anindividual's clinical profile, hierarchies should be used tocharacterize the person's illness level with each disease process; 5)the diagnosis classification should encourage specific coding; 6) thediagnostic classification should not reward coding proliferation; 7)providers should not be penalized for recording additional diagnoses; 8)the classification system should be internally consistent; 9) thediagnostic classification should assign all ICD-9 codes; and 10)discretionary diagnostic categories should be excluded from paymentmodels.

The Risk Adjustment Factor (RAF) is calculated by adding together ademographic factor (based upon, for example, the age and sex of thepatient) and the total of a Hierarchical Condition Category (HCC) riskadjusted diagnosis. There are seventy disease categories, with over3,100 diagnoses, available to apply toward the HCC risk adjusteddiagnosis. A particular numerical “risk factor” is assigned to eachcategory. Since the HCC is an additive model, the risk factor from alldiagnoses are combined to reach the total RAF. Furthermore, the HCC is apredictive model, i.e., it is utilized to determine a future yearpayment based on coding this year's date of service. In summary, ahigher RAF is obtained by sicker patients, thereby resulting in higherpayments; whereas healthier patients will have a lower RAF, resulting inlower payments.

In particular, payments are determined through diagnosis coding afterproviding face to face patient evaluation at least once a year. As such,appropriate chart documentation and diagnosis reporting is required foraccurate reimbursement. This documented information is submitted fromthe healthcare provider to the patient's health plan (HP), which in turnsubmits the data to the Centers for Medicare and Medicaid Services(CMS). CMS then takes the provided data and scrubs it for duplicationand accuracy. The scrubbed data is then used by CMS to determine therevenue to provide to the HP. The HP then reimburses the health careprovider based upon their contract. As such, it can readily be seen thatproper diagnosis coding drives the RAF scorers, which in turn drives thereimbursement. Without proper documentation, the full reimbursement willnot be retained.

It is important to note that with proper coding, patient care remainsthe priority. Once appropriate care is delivered to the patient, how toproperly code for that care becomes important. However, care is notaltered to meet coding strategies; rather, the reverse is the case,i.e., proper care drives proper coding. CPT codes reflect the level ofcare provided, but ICD-9 codes reflect the disease state addressed.Disease states submitted for a specific visit must be addressed anddocumented for that visit. The most missed diagnoses in senior patientsare chronic kidney disease, peripheral vascular disease, peripheralneuropathy, and major depression. In order to properly document apatient visit, the chart must contain the patient's name (on each page,if the notes span multiple pages), the patient's date of birth or someother unique identifier, the date of service, and a handwritten orelectronic signature of the caregiver, including credentials.Furthermore, validated HCC coding requires three documented points: 1)The diagnosis or assessment; 2) the status or condition (e.g., stable,condition worsening, medication adjusted, tests ordered, documentationreviewed, condition improving, etc.); and 3) a plan of action. Under theofficial ICD-9 coding guidelines, a diagnosis can only be coded when itis explicitly spelled out in the medical record. Accordingly, alldocumentation used for coding must be specific, and the mere fact that apatient has a condition is not sufficient on its own. Additionally,under ICD-9 guidelines, a diagnosis cannot be coded unless it is statedin the current visit documentation. All conditions that coexist at thetime of the visit should be coded if they require or affect patientcare, treatment, or management and are addressed in the medical recordfor the specified visit.

As discussed above, merely listing diagnoses is not sufficientdocumentation, as a diagnosis, status, and plan of action must all bedocumented for proper coding. Furthermore, merely listing medicationsdoes not meet documentation requirements to indicate that an evaluationfor that condition was done. Also, superbills, encounter forms, andreferrals are not acceptable forms of documentation as they are notconsidered a part of the medical record. Therefore, when a diagnosticreport is provided it must be interpreted by the medical practitionerand documented for proper coding purposes. Additionally, a diagnosismust be presented unconditionally, without using terms such as “ruledout”, “probable”, “consistent with” and the like.

In an attempt to verify that diagnoses are being properly documented,CMS annually audits medical records. These audits are called RiskAdjustment Data Validation (RADV). Health plans, hospitals, medicalgroups, and physician offices are required to comply with CMS requestsfor medical records, and unsubstantiated diagnoses may result inrecoupment of payments. In particular, the documentation substantiatingthat the patient was evaluated, monitored, or treated for the conditionis a requirement for receiving reimbursement and must include all threeof a diagnosis, status, and plan of action.

It is important to note that causal relationships of diseases need to beexplicitly stated in the record, they cannot be inferred. Accordingly,linkage can be established in the chart with terms such as the specificdisease being “due to”, “associated with”, “secondary to” or the likeshould be used to establish a cause and effect relationship. Terms suchas “with”, “probable”, “more than likely” and the like do notsufficiently support linkage. For example, merely charting Type IIDiabetes and Chronic Kidney Disease results in a significantly lower HCCRAF weight than would a proper charting of Type II Diabetes with RenalManifestations and Chronic Kidney Disease due to Diabetes. Coding in thelatter manner leaves no room for error in interpretation as to thedisease states.

Another key aspect of proper charting is the correct documentation of apatient's “history of” a disease. The “history of” a disease should onlybe charted when the patient has been cured and is no longer beingactively treated for the disease. A “history of” indicates that themedical condition no longer exists and the patient is not receiving anytreatment, but there is the potential for recurrence and thereforerequires continued monitoring. A “history of” a disease should not beused to describe a current acute or chronic condition even if it iscontrolled on medication. As long as the condition exists, despitetotally successful and stable status, the condition must be coded as anactive condition.

On an at least annual basis, a patient's chronic and active conditionsshould be documented so as to not overlook certain conditions. Forexample, chronic heart failure (CHF), chronic obstructive pulmonarydisease (COPD), diabetes mellitus (DM), chronic kidney disease (CKD),neuropathy, and peripheral vascular disease (PVD) are chronic conditionsthat should be charted and are commonly unreported diagnoses.Furthermore, the patient's medication list should be reviewed to ensurethere is a diagnosis associated with each medication. While patient careremains the priority at all times, without proper documentation in themedical record reimbursement will not occur. Following are certainexamples of chronic conditions and proper methods of charting.

Diabetes

More than sixty percent of seniors with diabetes have a manifestation orcomplication of the diabetes. These complications must be properlycharted, but are the most frequently omitted conditions in physicianmedical records. Good quality of care and reimbursement rely on thedetails. For example, it needs to be documented whether the patientsuffers from Type I or Type II, whether there are complicationsassociated with the diabetes, which systems are affected by thecomplications, and whether the blood glucose levels are controlled oruncontrolled.

When complications are due to diabetes, the documentation must make thatconnection explicitly. Additionally, every patient with diabetes shouldbe evaluated for the many manifestations, complications, andco-morbidities of the disease, with progress notes and tests to show theevaluation was done. Exemplary possibilities are renal, ophthalmic,neurological, circulatory, other specified, and unspecifiedmanifestations. Diabetes with manifestation codes have higher RAFs and,therefore, receive higher reimbursements. Even though only the highestweighted diabetes code will count toward the risk adjusted HCC model,all applicable manifestations should be charted.

Diabetes with manifestations require at least two separate codes; onefor the diabetes with manifestation and one for the supportingassociated diagnosis. For example, a patient with “diabetes with renalmanifestation”, aside from receiving a code for the diabetes, would alsorequire a second code for what the manifestation is. Incomplete codingof the diabetes with renal manifestation by itself does not fullydescribe the manifestation or complication and would not receive theappropriate RAF.

Chronic Kidney Disease

Coding for CKD conforms to the stages of CKD, including stages I-IVbased on a patient's glomerular filtration rate (GFR) (estimated from aurinalysis and/or serum creatinine levels) and/or kidney damage.However, some patients with “normal” creatinine levels have significantrenal function impairment. As such, CKD-I and CKD-II are commonlymissed. For those at risk of renal disease, creatinine clearance of GFRshould be estimated at least twice per year. Further, the cause of theCKD should be checked and coded for a cause and effect linkage, forexample, diabetes or hypertension. Unspecified kidney issue terminologysuch as chronic renal disease, chronic renal failure, and chronic renalinsufficiency do not affect the RAF and should be avoided in favor ofmore specific diagnoses.

Cardiology

An important issue when documenting a significant cardiac diagnosis isto be specific. For example, less specific terms, such as, coronaryartery disease or atherosclerotic heart disease, should be avoided ifthe patient has more specific diagnoses, such as, angina or history ofmyocardial infarction (MI). An acute MI is considered to be present forthe first eight weeks after occurrence. If a patient is seen eight weeksafter an acute MI and has not continued anginal symptoms, the codingshould be changed to recent, old, or history of MI.

Cardiac angina is coded if currently being treated and may be continueto be coded even if asymptomatic due to pharmacological treatment. Otherongoing chronic cardiac conditions, such as, atrial fibrillation orarrhythmias should be documented and coded whether symptomatic orasymptomatic if continued pharmacological treatment or interventionalcardiology is present. Of note, congestive heart failure is always achronic condition after diagnosis, and echocardiograms should be used toevaluate and document diastolic heart failure.

Malnutrition

Malnutrition is often observed in senior patients due to conditions thatlimit nutrient ingestion and absorption, such as, cancer, pancreatitis,alcohol abuse, liver disease, obesity, CHF, COPD, end stage renaldisease (ESRD), celiac disease, cystic fibrosis, depression, anddementia. However, malnutrition is often underreported and merelyreported as being “underweight”, “failing to thrive”, or “loss ofappetite” which do not affect the RAF. In these situations, occurrencesof malnutrition should be identified.

Psychiatry

Episodic mood disorders are mental diseases that include mooddisturbances such as major depression. The characteristics of these mooddisturbances should be carefully documented and specific mental disorderterminology should be used in the final diagnosis, otherwise there willbe no RAF adjustment. Furthermore, maladaptive patterns of substanceuse, leading to clinical impairment or distress should be coded as adependence, rather than abuse.

Oncology

Malignancies are only coded until the patient has completed definitivetreatment, such as surgery, chemotherapy, and/or radiation therapy aimedat eradicating the malignancy. Furthermore, breast and prostate cancerpatients on adjuvant therapy are coded as having the active disease.However, once a patient has completed therapy, he or she can only becoded with a “personal history of cancer” diagnosis even if undergoingsurveillance for reoccurrence of the malignancy.

It is extremely important to document when metastatic disease ispresent, as it has a separate coding section and CMS-HCC payment group.In this case, lack of specificity in the documentation can lead directlyto a lower payment rate. Often, metastases are not clearly identified,thereby improperly leading to the coding of multiple primary malignancysites.

Podiatry

Commonly under-diagnosed HCC conditions may be uniquely discovered bypodiatrists, such as peripheral vascular disease, peripheral neuropathy,and skin ulcers. Again, if these conditions are due to a patient'sdiabetes, it is important to document by using two separate codes: onefor the diabetes with circulatory or neurological manifestations and onefor the supporting manifestation code.

Software for Electronic Medical Records

As can be seen from the examples provided above, there are numerouspitfalls that can be fallen into when documenting a patient's medicalrecord, resulting in improperly coded, and under-reimbursed, diagnoses.Certain goals of the present invention are to train caregivers toproperly document medical diagnoses and to provide a software platformfor taking, storing, and aiding the caregiver in properly coding themedical records of patients.

Aside from, and in addition to, the training provided to caregivers inproper coding methodologies, as discussed in greater detail above, thepresent invention envisions a software platform (herein referred to asiCode) to improve compliance with CMS' s correct coding initiative andHCC extraction and reporting. iCode allows for the enhanced care ofMedicare Advantage enrollees, provides valuable information to thecaregiver at the point of care, reduces duplicate and costly services byproviding a comprehensive clinical history for each patient, and assistswith capturing qualifying CMS-HCC codes.

In particular, iCode is capable of importing data from a caregiver'scurrent medical records, billing files, health plan claim files, and thelike. iCode then auto-populates each field from the data import tocreate new electronic medical records, analyzes the data, and createsreports of the analyzed data. Examples of such reports include, patientdemographic information, health plan eligibility history, outstandingtests/procedures affecting performance per HEDIS measurements, summaryof reported chronic conditions, list of potential unreported HCCs perreview category, list of three year medical history by ICD-9 and CPTclassifications, last six months of pharmacy data, and notes andcomments. All captured data fields can be output as an iCode report.

Of particular relevance, however, is the ability of iCode to recommendpotential missed coding opportunities based upon the medical conditionsthat have been entered in relation to historically incorrectly reportedor underreported conditions. For example, iCode may recommend to thecaregiver that in order for proper coding, a diagnosis of a disease, thestatus of the disease, and a plan of action must all be recorded.

Similarly, iCode may recommend to the caregiver that certain diseasecodes which do not affect the RAF have similar codes that do affect theRAF and may have been overlooked. For example, if a caregiver records a“history of” a disease, when in fact the patient is still suffering fromthe disease state, or if the records indicate less specific terminologyfor a disease state which may be more accurately described with acondition that does affect the RAF.

Another example of a suggestion iCode may make to the care giver iswhether related complications of a disease have been improperly coded,or not coded at all. For example, patients suffering from diabetestypically have other disease states that are complications from theunderlying diabetes. Unless these conditions are coded as deriving fromthe underlying diabetes, the RAF score is not properly assigned.

Additionally, iCode may recommend, upon annual reviews, that eachmedication prescribed to the patient needs a corresponding diseasediagnosis coded, or recommend potential commonly miscoded or unreporteddiseases, such as chronic kidney disease, peripheral vascular disease,or malnutrition.

Along these lines, the recommendations provided by iCode are just that,recommendations. It is noted that the iCode software will never makechanges or adjustments on its own to the entered medical records, butrather acts as a warning system to the caregiver for potentiallyoverlooked diagnoses that should be coded on further inspection by thecaregiver.

Additional modifications and improvements of the present invention mayalso be apparent to those of ordinary skill in the art. Thus, theparticular combinations of parts and steps described and illustratedherein is intended to represent only certain embodiments of the presentinvention, and is not intended to serve as limitations of alternativedevices and methods within the spirit and scope of the invention.

1. A method of recording a patient's medical documents comprising: a.obtaining medical data from the patient, wherein the data comprisesdisease codes; b. storing such data obtained in step (a) in electronicmedical records embodied on a computer readable medium; c. evaluatingsaid data stored in step (b) via a computer capable of interpreting saidelectronic medical records to ensure that the data entry is complete;and d. presenting a notification if any of the data evaluated in step(c) is found to be incomplete or incorrect.
 2. The method of claim 1,wherein the disease codes are ICD-9 codes.
 3. The method of claim 1,wherein the evaluation in step (c) comprises evaluating whether for eachdisease code there is recorded a corresponding diagnosis of the disease,status of the disease, and plan of action for the disease.
 4. The methodof claim 1, wherein the evaluation in step (c) comprises evaluating theobtained disease code to determine whether an improper code has beenentered.
 5. The method of claim 4, wherein the obtained disease code isevaluated to determine whether a more specific code should be used. 6.The method of claim 4, wherein the evaluation of the obtained diseasecode is determining whether a current disease has been improperly codedas a history of the disease.
 7. The method of claim 1, wherein theevaluation in step (c) comprises evaluating whether there are likelydisease codes that have not been obtained in step (a).
 8. The method ofclaim 7, wherein if a diabetes code is obtained in step (a), anotification in step (d) is presented to the user that complications ofdiabetes should be properly coded.
 9. The method of claim 1, wherein thedata obtained in step (a) further comprises medication prescriptions ofthe patient.
 10. The method of claim 9, wherein the evaluation of step(c) determines whether there is a linking disease code for eachmedication prescription.
 11. The method of claim 1 further comprisingpresenting a notification to the user of the system to review themedical records for commonly unreported or miscoded diseases within apopulation of patients.
 12. The method of claim 11, wherein the commonlyunreported or miscoded diseases are selected from the group consistingof chronic kidney disease, neuropathy, peripheral vascular disease, andmalnutrition.
 13. A method of training healthcare providers to properlyrecord medical documents, said method comprising the steps: a.evaluating the healthcare provider's current medical documentationprocess; b. training the healthcare provider in methods of recordingmedical documents; c. providing a system for recording medicaldocuments, wherein the system comprises: i. a computer readable mediumcapable of storing medical data obtained from patients, wherein the datacomprises disease codes; ii. a computer with software capable ofevaluating the data stored on the computer readable medium forcompleteness; and iii. a notification system capable of presenting tothe user of the system a warning if any of the data is found to beincomplete or incorrect; and d. training the healthcare provider in useof said system.
 14. The method of claim 13, wherein the trainingprovided in step (b) comprises instructing the healthcare provider toensure the medical documents are sufficiently detailed and coded toachieve the correct RAF score.
 15. A system for recording medicaldocuments comprising: a. a computer readable medium capable of storingmedical data obtained from patients, wherein the data comprises diseasecodes; b. a computer with software capable of evaluating the data storedon the computer readable medium for completeness; and c. a notificationsystem capable of presenting to the user of the system a warning if anyof the data is found to be incomplete or incorrect.
 16. The system ofclaim 15, wherein the notification system presents a warning if adisease code does not have a corresponding recorded diagnosis ofdisease, status of disease, and plan of action for the disease.
 17. Thesystem of claim 15, wherein the notification system presents a warningif an improper disease code has been entered.
 18. The system of claim15, wherein the notification system presents a warning if there arelikely disease codes that have not been recorded.
 19. The system ofclaim 15, wherein the notification system presents a warning if amedical prescription is recorded without a linking disease code for themedication.